Still in the Shadows: Kirby report turns a blind eye to women

Almost twenty years ago, the Canadian Mental Health Association (CMHA) issued an in-depth report calling for action to address mental health concerns facing women in Canada. Women and Mental Health in Canada: Strategies for Change warned of the dire mental health effects of the feminization of poverty and violence against women and drew attention to the disproportionate number of women assigned with the diagnostic categories of depression and anxiety. It outlined 25 recommendations for improvement, including the development of affordable, high quality child care services, the establishment of pay equity policies, recognition of unpaid caregiving, and the creation of a national clearinghouse of research and programs on women’s mental health.

The report was promptly buried, its recommendations consigned to oblivion.

In May 2006, the Senate Committee on Social Affairs, Science and Technology, chaired by Senator Kirby, released a new three-year study on mental health, mental illness and addiction in Canada. Out of the Shadows at Last reveals massive gaps in Canadian mental health care which aggravate illness and offload care to families—particularly women, and highlights social factors, like the housing crisis, that are crucial for integration and healing. Its recommendations to expand care and increase supportive housing are good news for women, who make up the majority of unpaid care-givers in Canada.

Given these welcome interventions, the Kirby Report’s silence on significant differences between men and women’s mental health, mental illness and addiction is distressing.

Canadian figures bear out those differences. Health service utilization data from Manitoba and Quebec over the past ten years shows that substantially more women than men received a diagnosis of a mental health problem and of an anxiety/ depressive disorder and that more women than men received a psychotropic or an anti-anxiety drug or antidepressant. In Canada, 13% of women versus 9% of men consume sedative-hypnotic drugs. Data from the Canadian National Population Health Survey indicate that women are more likely to experience a major depressive episode, with annual incidence rates of depression twice as high as those of men. Women are more than twice as likely as men to walk out of the doctor’s office with an anti-anxiety or anti-depressant prescription.

The pattern continues with addictions. Women’s bodies are more susceptible to the effects of alcohol, tobacco, and other drugs, and women develop many substance-related health problems, such as alcohol-related liver disease, earlier than men. Substance use and mental health problems also frequently co-occur among women who are survivors of violence, trauma, and abuse, often in complex, indirect, mutually reinforcing ways – as many as two-thirds of women with substance use problems report a concurrent mental health problem such as post-traumatic stress disorder, anxiety, and depression.

International mental health authorities are increasingly mindful of these differences and their causes. Organizations like the World Health Organization (WHO) have recognized that certain common mental disorders affect women disproportionately and in unique ways, often triggered by risk factors like gender-based violence, socioeconomic disadvantage, low income and income inequality, and primary responsibility for care-giving. In September 2005, the World Psychiatric Association (WPA) passed the International Women’s Mental Health Consensus Statement, signed by 140 of its member associations. The statement, which calls for mental health policy to address women’s unique roles in reproduction, family and society, and their often lower socioeconomic status, has been endorsed by several other international organizations, including the World Federation of Mental Health.

Yet despite the mounting evidence – as well as Canada’s many commitments to using Gender-Based Analysis (GBA) in policy and program development – federal health studies somehow remain gender-blind. Out of the Shadows is no exception. Its inattention to differences in women and men’s bodies and social conditions leaves little hope that its proposed solutions will address women’s mental health needs.

In a bid to rekindle the discussion, a national ad hoc working group convened by the Canadian Women’s Health Network pooled the knowledge of over 25 women’s mental health experts from across the country to produce a series of recommendations for improving mental health response and promotion, as well as a set of briefing notes on women’s mental health issues ranging from trauma, depression, psychotropic drugs and eating disorders to population-specific issues.

But we need more than another report. The great task of healing our mental health care system must be built around a close examination of gender and diversity. We need a balance of women and men within the Kirby Report’s proposed Mental Health Commission, a systematic gender review of mental health, mental illness and substance use in Canada, and greater support for women-centred models of care. We need to address the impacts of poverty and sexual and intimate partner violence on women’s mental health, and earmark funds for conditions like depression and trauma-related disorders, which affect women disproportionately.

Twenty years is a long wait, and one we can ill afford to repeat. How much longer will women’s needs as patients, providers, paid and unpaid care-givers continue to remain in the shadows?

Laila Malik is a women's rights policy researcher, writer and editor. She was involved in convening the Ad Hoc Working Group on Women, Mental Health, Substance Use and Addictions as acting Director of Communications of the Canadian Women's Health Network.